E04.9
BillableNontoxic goiter, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E04.9 an HCC code?
No. E04.9 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for E04.9
For E04.9to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed E04.9 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E04.9 is the ICD-10-CM diagnosis code for nontoxic goiter, unspecified. An enlarged thyroid gland that is not producing excess thyroid hormone, where the specific type or cause has not been determined. This is a common condition that can occur due to iodine deficiency, genetics, or other factors. E04.9 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering disorders of thyroid gland (e00-e07).
E04.9 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code does not map to any HCC under V24 or V28, providing no community risk adjustment impact. It maps to RxHCC 44 (Osteoporosis, Vertebral and Pathological Fractures). The unspecified nature limits both clinical and risk adjustment value, and efforts should be made to assign a more specific code.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E04.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use E04.9 only when the documentation does not specify the type of nontoxic goiter (such as diffuse, nodular, or endemic); if a specific type is documented, use the more specific E04.0-E04.8 codes instead
- •Verify that the goiter is confirmed as nontoxic (not causing hyperthyroidism) before coding; if thyroid function tests show toxicity, use codes from the E05 category instead
Clinical Significance
Nontoxic goiter, unspecified, captures thyroid enlargement with normal thyroid function where the morphological pattern (diffuse, nodular, multinodular) has not been specified. This is a non-specific code that should prompt further characterization through thyroid ultrasound. Goiter prevalence varies by region and iodine intake, and the unspecified designation limits clinical utility for management planning.
Documentation Requirements
- ✓Documentation requires a confirmed diagnosis of goiter with normal thyroid function.
- ✓However, the provider should be queried to specify the morphological type based on examination or imaging findings.
- ✓Thyroid function tests confirming euthyroid status, physical examination findings, and any planned imaging should be recorded.
- ✓This code should be considered temporary pending more specific characterization.
Commonly Confused Codes
- •E04.0 (Nontoxic diffuse goiter), E04.1 (Nontoxic single thyroid nodule), E04.2 (Nontoxic multinodular goiter), and E04.8 (Other specified nontoxic goiter) are all more specific alternatives.
- •E01.2 (Iodine-deficiency related goiter, unspecified) captures unspecified goiter with iodine-deficiency etiology.
- •E05.00-E05.90 (Thyrotoxicosis) codes are used when goiter is associated with hyperthyroidism.